Prosthetic hip joint infection by Bacillus Calmette-Guerin therapy following intravesical instillation for bladder cancer identified using whole-genome sequencing: a case report

BMC Infectious Diseases

Jonathan Stevenson¹  Gerald Langman²  Michael Riste³  Neil Jenkins³  Martin Dedicoat³  Matthew K. O’Shea⁴  Steven Laird⁵  Simantini Jog⁵  E. Grace Smith⁶  David H. Wyllie⁶  Pretin Davda⁶ 

[1] Bone Infection Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK;Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Department of Infectious Diseases, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK;Department of Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;National Mycobacterial Reference Service, Public Health England, Heartlands Hospital, Birmingham, UK;

关键词: Mycobacterium bovis;    Bacillus Calmette-Guerin;    Intravesical BCG therapy;    Prosthetic joint infection;    Whole-genome sequencing;    Case report;   

DOI  :  10.1186/s12879-021-05831-3

来源: Springer

【 摘 要 】

BackgroundJoint replacement is an effective intervention and prosthetic joint infection (PJI) is one of the most serious complications of such surgery. Diagnosis of PJI is often complex and requires multiple modalities of investigation. We describe a rare cause of PJI which highlights these challenges and the role of whole-genome sequencing to achieve a rapid microbiological diagnosis to facilitate prompt and appropriate management.Case presentationA 79-year-old man developed chronic hip pain associated with a soft-tissue mass, fluid collection and sinus adjacent to his eight-year-old hip prosthesis. His symptoms started after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Synovasure™ and 16S polymerase chain reaction (PCR) tests were negative, but culture of the periarticular mass and genome sequencing diagnosed BCG infection. He underwent a two-stage joint revision and a prolonged duration of antibiotic therapy which was curative.ConclusionsBCG PJI after therapeutic exposure can have serious consequences, and awareness of this potential complication, identified from patient history, is essential. In addition, requesting appropriate testing is required, together with recognition that traditional diagnostics may be negative in non-pyogenic PJI. Advanced molecular techniques have a role to enhance the timely management of these infections.

【 授权许可】

CC BY